Be a driving force behind EBP
Learn why evidence is a must when it comes to quality patient care.
evidence-based practice
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Nurses are doing the digging to find answers to their practice questions.
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You hold the power
Bedside nurses have the ability to make significant practice changes.
Making the grade
Evidence is a moving target. Be ready to adjust EBP policies.
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evidence-based practice
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CE Catalog
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You know EBP is important; now grasp the strategies behind it.
The journey continues
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An unacceptable risk
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Training days
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Pregame practice
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Patient care gets revamped
A cancer center reboots bedside reporting and improves care.
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Use high-quality evidence-based practice in your work
Ensure your EBP makes the grade
Karen Schmidt, RN
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Evidence-based practice has advanced and led to improvements in nursing care. But nurses who depend on an EBP model cannot stop using their critical thinking and nursing assessment skills when applying that model to their patient care.
“Evidence is a moving target,” said Patricia A. Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAANP. A nurse consultant, Quigley is the retired associate director of Veterans Integrate Service Network 8 Patient Safety Research Center of Inquiry. She worked in rehabilitation nursing since 1977, serving with the Veterans Administration for 32 years.
Qualifying research
Quigley’s research has shown her that not all scientific evidence is of equal importance. For example, as a clinical nurse specialist, she read literature about the effectiveness of fall and fall injury prevention programs in hospitals, and found little evidence of effectiveness. However, literature was available in long-term care and primary care settings. She questioned how to apply this knowledge to acute care settings through quality improvement and program evaluation.
There needs to be sufficient science out there before practice is changed as a result.”
— Patricia A. Quigley, ARNP
“I created a research agenda to address gaps in practice and led research programs to fill the gap,” she said. Her research also revealed that, in EBP, not all the scientific evidence is equal. "A lot of nurses think they’re doing EBP; they need to read the literature content and grade the evidence,” she said.
Quality of nursing care depends on the quality of the evidence, she said. “When you’re conducting research, you have to ask, ‘What is the state of the science?’” she said. "There needs to be sufficient science out there before practice is changed as a result.” Quigley recommended using grading scales to evaluate the evidence. Various scales exist, for example, United States Preventive Services Task Force Grading.

Examples of evidence-based practice
To reach and maintain best quality of care and true EBP, nurses should be primarily using grade A evidence. It is plentiful, tried and true, she said. For example, she said, nurses must evaluate the competency of the evidence for the use of nonskid socks. “If you look at the literature, the universal precautions say to put patients in the socks. If you’re putting them on everyone, you’re not using the evidence; you’re putting them on some of the wrong people.” Patients with a shuffling gait should not wear nonskid socks for falls prevention because the socks increase their trip hazard. Nurses who evaluate the practice based on the most competent, higher grade evidence will make the necessary critical decisions based on their assessments.
Steps in implementing EBP
Choose an EBP model and build the infrastructure to use it, Quigley recommended. If you know you have a gap in evidence, how will you close the gap? The model should guide nurses in how to review the science and go from inquiry to implementation. Choose a grading scale to evaluate the competency of the evidence and teach people how to use it.
Ask, "Do we have a staffing issue that doesn’t make this process feasible?" If so, don’t use that model, Hester said.
Start small. Make small tests of change first. If it doesn’t work, figure out why. “Be ready for barriers to implementation,” Quigley said.
Evaluation should be part of the model. “You need to be thoughtful of how you incorporate evidence into practice, or you set yourself up for failure,” Hester said.
“Evidence-based practice is closing the gap between what’s out there and what we’re doing,” Quigley said. “People are more engaged. They feel they have more autonomy. People love to see how they’re making a difference.”
Consider staffing in clinical decision-making
Amy Hester, PhD, RN, BC, agreed that implementing EBP means going beyond a simple screening tool. “EBP guides decision-making so nurses can choose what interventions and EBP are best for each patient. It allows the nurse to personalize and individualize care for preventing falls with injury,” she said.

Hester is director of nursing research and innovation for University of Arkansas for Medical Sciences in Little Rock. Her research led her to co-develop the Hester Davis Scale for Fall Risk Assessment. While working on a neurology/neurosurgery unit in 2008, Hester began researching falls prevention after recognizing that the unit had a problem.

“Nurses used an EBP bundle in preventing falls, but didn’t evaluate which single practices [in the bundle] were needed," she said. In 2010, after a fall-related patient death, her research team started testing single interventions to find out what was effective in preventing falls and what wasn’t. "When we implemented the EBP model, we found that the risk assessment tool didn’t point us in the right direction about what patient needed what care.”
Hester also said staffing, among other components, is affected by EBP. “It directly impacts the time nurses have to spend in implementing EBP,” she said. “Time equates to compliance," she continued. "How compliant is the nurse in keeping to the standards of the institution? The connection is that you can have all the EBP related to any outcome or treatment plan, but if staffing issues mean a nurse doesn’t have enough time, there cannot be compliance with that EBP.” In applying science to practice, Hester, like Quigley, said evidence needs regular evaluation. “EBP is in constant evolution,” she said. “It’s never a stagnant set of rules — there is always new evidence and new science. We have to keep a pulse on things that are coming out.”

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Karen Schmidt, RN, is a freelance writer.